Provider Demographics
NPI:1790026169
Name:WALLER SAWYER, ANYA EVELYN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANYA
Middle Name:EVELYN
Last Name:WALLER SAWYER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 WAYNE ST
Mailing Address - Street 2:402A
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3440
Mailing Address - Country:US
Mailing Address - Phone:201-500-5077
Mailing Address - Fax:
Practice Address - Street 1:121-125 NEWARK AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-5863
Practice Address - Country:US
Practice Address - Phone:201-500-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00088400171100000X
NY25 004768171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist